Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by overproduction of red blood cells. We have performed a comprehensive characterization of blood immune cells for expression of ...naïve and memory receptors as well as β
2
m-associated and β
2
m-free MHC class I heavy chains, also known as closed and open conformers, respectively, in PV patients and age-matched controls (CTR). We show that the peripheral CD3
+
CD8
+
T cell pool in PV patients is clearly divided into two discrete populations, a more granular CD3
+
CD8
high
T cell population enriched in effector-memory CD45RA
+
T cells (CD8
+
T
EMRA
) when compared to CTR (
P
< 0.001), and a less granular CD3
+
CD8
int
T cell population that is completely absent in the CTR group (78 vs. 0%,
P
< 0.001) and is a mixture of naïve (CD8
+
T
N
) and CD8
+
T
EMRA
cells expressing intermediate levels of CD28, i.e., CD3
+
CD8
int
CD28
int
. While the percentage of CD3
+
CD8
int
T
N
cells correlated positively with the number of erythrocytes, the percentage of CD3
+
CD8
int
T
EMRA
correlated negatively with the number of platelets. Finally, we report that PV patients’ lymphocytes and monocytes display lower levels of closed (W6/32
+
) MHC-I conformers at the cell surface while exhibiting increased amounts of open (HC-10
+
) MHC-I conformers. The implications of this distinctive immune signature are discussed.
This study aimed to obtain a bifunctional fabric from the point of view of hydrophilicity/hydrophobicity for biomedical applications. To achieve this, both sides of a fabric of polylactic acid (PLA) ...were subjected to a plasma treatment. While in a side the oxygen was introduced to the other side, simultaneously, was added methane. The plasma treatment was performed at 100 W, 1.8 mbar, during 30 minutes. By Scanning Electron Microscopy (SEM) morphological analysis, it became evident that the fabric side facing the oxygen inlet showed micropittings, while the reverse side had smooth surfaces. Analysis by X-Ray photoelectron spectroscopy (XPS) revealed an increase in the amount of oxygen in the surface of the PLA on both sides of the fabric. The surface function was characterized by measurements of water absorption rate, where it was determined that one fabric side was more hydrophilic than the other side. The results indicated achievement of a bifunctional fabric through orientation of working gases during a plasma treatment.
Evidence on timing for mobilization after chronic subdural hematoma (cSDH) surgery is heterogeneous, and practices differ considerably among neurosurgical centers. The Impact of an Early Out-of-Bed ...Paradigm in Postoperative Outcomes of Chronic Subdural Hematomas: GET-UP Randomized Prospective Trial (GET-UP Trial) is a randomized clinical trial comparing a postoperative early mobilization protocol to bed rest. Previously reported results at clinical discharge and 1 month after surgery indicated a decreased risk of medical complications in the early mobilization group. Herein, the authors report outcomes at the 1-year follow-up.
The GET-UP Trial is a prospective, randomized, unicentric, open-label study with an intention-to-treat primary analysis designed to evaluate the impact of an early mobilization protocol after burr hole craniostomy for cSDH on the occurrence of medical complications and functional outcomes. Between January 2019 and August 2021, a total of 208 patients were recruited and randomized to either an early mobilization group, in which patients began elevation of the head of the bed within the first 12 hours after surgery, or to a bed rest group, in which patients remained recumbent for 48 hours. Outcomes assessed at the 1-year follow-up included functional status as measured by the Glasgow Outcome Scale-Extended (GOSE) and repeat surgery for hematoma recurrence (surgical recurrence).
A total of 203 patients completed 1 year of follow-up: 101 in the bed rest group and 102 in the early mobilization group. No significant baseline pre-randomization clinical differences were observed between the two management groups. At 1 year after surgery, a favorable functional outcome, defined as a GOSE score ≥ 5, was observed in 59 patients (58.4%) in the bed rest group and 78 (76.5%) in the early mobilization group (p = 0.006). Death occurred in 25 patients (24.8%) in the bed rest group and 16 (15.7%) in the early mobilization group (p = 0.108). Surgical recurrence was noted in 6 patients (5.9%) in the bed rest group and 7 (6.9%) in the early mobilization group (p = 0.788). Multivariate analysis showed an independent association between early mobilization and an increase in favorable functional outcomes (OR 2.006, 95% CI 1.076-3.739, p = 0.028).
The GET-UP Trial is the first randomized clinical trial assessing the impact of mobilization strategies on medical complications after burr hole craniostomy for cSDH. Regarding functional results 1 year after surgery, early mobilization was associated with an improvement in functional outcomes without an increase in surgical recurrence. These findings support the preference for an early mobilization protocol in cSDH patients over mandatory bed rest strategies.
Timing of mobilization after chronic subdural hematoma (cSDH) surgery is highly heterogeneous among neurosurgical centers. Past studies have suggested that early mobilization may reduce medical ...complications without increasing recurrence, but evidence remains scarce. The purpose of this study was to compare an early mobilization protocol with a 48-hour bed rest practice, with a focus on the occurrence of medical complications.
The GET-UP Trial is a prospective, randomized, unicentric, open-label study with an intention-to-treat primary analysis designed to evaluate the impact of an early mobilization protocol after burr hole craniostomy for cSDH on the occurrence of medical complications and functional outcomes. A total of 208 patients were recruited and randomly assigned to either an early mobilization group where they began head-of-bed elevation within the first 12 hours after surgery and proceeded to sedestation, orthostatism, and/or walking as rapidly as tolerated, or to a bed rest group where they remained recumbent with a head-of-bed angle inferior to 30° for 48 hours after surgery. The primary outcome was the occurrence of a medical complication (defined as either an infection, seizure, or thrombotic event) after surgery and until clinical discharge. Secondary outcomes included length of stay measured from randomization to clinical discharge, surgical hematoma recurrence at clinical discharge and 1 month after surgery, and Glasgow Outcome Scale-Extended (GOSE) assessment at clinical discharge and 1 month after surgery.
A total of 104 patients were randomly assigned to each group. No significant baseline clinical differences were observed before randomization. The primary outcome occurred in 36 (34.6%) patients included in the bed rest group and 20 (19.2%) in the early mobilization group (p = 0.012). At 1 month after surgery, a favorable functional outcome (defined as GOSE score ≥ 5) was observed in 75 (72.1%) patients in the bed rest group and 85 (81.7%) in the early mobilization group (p = 0.100). Surgical recurrence occurred in 5 (4.8%) patients in the bed rest group and 8 (7.7%) in the early mobilization group (p = 0.390).
The GET-UP Trial is the first randomized clinical trial to assess the impact of mobilization strategies on medical complications after burr hole craniostomy for cSDH. Early mobilization was associated with a reduction in medical complications without a significant effect on surgical recurrence, compared with a 48-hour bed rest protocol.
A economia dos países pode estar relacionada com políticas aplicadas na área da saúde e, nos últimos 10 anos, muitos países têm sofrido crises económicas profundas. O desafio cresce quando os ...orçamentos diminuem devido às dificuldades económicas sentidas e, em particular, com o orçamento dirigido à saúde. Tal foi evidente em Portugal, e nos países de Leste, como a Eslovénia, recente membro da União Europeia, embora menos evidente.O objectivo desta dissertação é comparar ambos os países no que diz respeito aos seus sistemas de saúde, para melhor compreender a sua respectiva dinâmica. Mais concretamente focando o seu modelo de financiamento, prestação e suas instituições, que nos permita compreender em que pontos se assemelham e, por outro lado, onde divergem, e tentar desenvolver uma lista de recomendações. Com esta comparação, os resultados alcançados poderão ser aplicados na revisão de políticas de cada país, permitindo uma maior aprendizagem, evitando erros e alcançando sucessos.Esta dissertação compara Portugal e Eslovénia tendo em consideração os seus sistemas de saúde utilizando o modelo teórico proposto por Avedis Donabedian, dividido em Estrutura, Processos e Resultados. Os diversos indicadores são usados para esta análise encaixando nesta framework analítica.Os sistemas de saúde português e esloveno possuem pontos coincidentes para análise, nomeadamente, os cuidados de saúde primários, secundários e terciários, esperança de vida ao nascimento, mortalidade infantil, anos de vida potencialmente perdidos, mortalidade considerando todas as causas e mortalidade devido a enfarte agudo do miocárdio e acidente vascular cerebral. Contrariamente, o financiamento dos sistemas de saúde, os indicadores de qualidade dos cuidados de saúde primários, as camas hospitalares, infra-estruturas onde são fornecidos os cuidados, consultas com médicos, as altas hospitalares, o tempo médio de internamento, o tempo de espera para cirurgias electivas, a mortalidade por causas seleccionadas e a auto-percepção do estado de saúde diferem entre ambos.Esta informação comparativa será importante para estabelecer novas iniciativas, dado que, tanto Portugal como a Eslovénia podem melhorar o seu sistema de saúde aprendendo um com o outro. Os sistemas de saúde no futuro irão enfrentar desafios relacionados com o envelhecimento da população e, consequentemente, o aumento das doenças crónicas. Investimentos futuros na rede de cuidados de saúde primários poderá permitir lidar com esta situação pois constitui uma pedra basilar de um bom sistema de saúde. Com o propósito de melhorar continuamente os sistemas de saúde deve ser incentivada a adopção de bons sistemas de informação, assim como o desenvolvimento de programas de guidelines nacionais, permitindo avaliação constante dos indicadores de saúde e melhoria na prestação e standardização dos cuidados de saúde, respectivamente.
Abstract
Onychomycosis or tinea unguium (EE12.1) and Onychomycosis due to non-dermatophyte moulds (1F2D.5) (OM) is a fungal infection of the nail plates with a high prevalence that often affects ...vulnerable people with co-existing health problems. Gold standard pharmacological treatments for onychomycosis have been associated with low success rates and increasing antifungal resistance, suggesting that treatment outcome is dependent on multiple variables. Here, the prevalence of OM and quality of life were characterized in two vulnerable populations—Hospital patients and Homeless people. Comparing both groups, the most prevalent fungal species were identified in Hospital patients. Then, the in vitro fungicidal properties of the antiseptics povidone-iodine, polyhexamethylene biguanide-betaine, octenidine dihydrochloride, and a super-oxidized solution against two ATCC strains (
Candida albicans
and
Aspergillus niger
) and three clinical fungal isolates from Hospital patients (
Candida parapsilosis
,
Trichophyton interdigitale
, and
Trichophyton rubrum
) were tested. OM prevalence was high in both patient groups studied, who also reported a reduction in quality of life and concerns about the state of their feet. In addition, Hospital patients had a non-negligent therapeutic regimen management style. Antiseptics tested in vitro revealed antifungal properties. As antiseptics are low-cost and easy to apply and have few iatrogenic effects, the demonstration of fungicidal properties of these solutions suggests that they may constitute potential supportive therapeutics for OM.
Refractory benign esophageal strictures (RBESs) have been treated with the temporary placement of different self-expanding stents with conflicting results. We compared the clinical effectiveness of 3 ...types of stents: self-expanding plastic stents (SEPSs), biodegradable stents, and fully covered self-expanding metal stents (FCSEMSs), for the treatment of RBES.
This study prospectively evaluated 3 groups of 30 consecutive patients with RBESs who underwent temporary placement of either SEPSs (12 weeks, n = 10), biodegradable stents (n = 10) or FCSEMSs (12 weeks, n = 10). Data were collected to analyze the technical success and clinical outcome of the stents as evaluated by recurrent dysphagia, complications and reinterventions.
Stent implantation was technically successful in all patients. Migration occurred in 11 patients: 6 (60%) in the SEPS group, 2 (20%) in the biodegradable group and 3 (30%) in the FCSEMS group (P = 0.16). A total of 8/30 patients (26.6%) were dysphagia-free after the end of follow-up: 1 (10%) in the SEPS group, 3 (30%) in the biodegradable group and 4 (40%) in the FCSEMS group (P = 0.27). More reinterventions were required in the SEPS group (n = 24) than in the biodegradable group (n = 13) or the FCSEMS group (n = 13) (P = 0.24). Multivariate analysis showed that stricture length was significantly associated with higher recurrence rates after temporary stent placement (HR = 1.37; 95% CI = 1.08-1.75; P = 0.011).
Temporary placement of a biodegradable stent or of a FCSEMS in patients with RBES may lead to long-term relief of dysphagia in 30 and 40% of patients, respectively. The use of SEPSs seems least preferable, as they are associated with frequent stent migration, more reinterventions and few cases of long-term improvement. Additionally, longer strictures were associated with a higher risk of recurrence.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PDF
